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7 Ways Parents Can Recognize Clinical Depression in Their Kids

When I speak with parents who are considering mental health treatment for their teenagers, the primary question they ask me is how to tell the difference between “typical” teen behavior and behavior that indicates there’s something more serious going on. A year ago, I would have been able to answer without hesitation: While some ups and downs are totally expected, watch out for social withdrawal, declining grades and high levels of anxiety or irritability. But, since March 2020, all of that has become more commonplace for teens around the country and the world. In the midst of a pandemic, with adolescents bearing the brunt of the mental health repercussions, it has become even more difficult to discern the tipping point when the stress and uneasiness we’re all feeling becomes a diagnosable disorder.

That said, parents do not need to sound the alarm every time a teenager has a mood swing, but they do need to pay very close attention to what’s happening. Given the physical changes and emotional turbulence that can be a part of the teenage experience, “teen angst” — which manifests as moodiness, irritability and anxiety — is part of the process of evolving and maturing into a healthy adult. Although it is not always comfortable to experience tension and frustration, it is actually a critical developmental process that helps teens learn more about how to navigate and understand their emotions.

However, major depressive disorder is a potentially life-threatening mental health condition, so it is essential not to downplay or overlook behaviors that might be symptoms of depression in teenagers. Research shows that 50 percent of all lifetime mental illnesses begin by the age of 14, and when left untreated, adolescent mental health issues become adult mental health issues. According to a study published in the American Journal of Psychiatry, 75 percent of teenagers who experience a depressive episode during adolescence later struggle with depression, other mood disorders, and/or substance use disorder as adults.

If you are a parent who’s having trouble understanding what your teen is going through, you are not alone. Forty percent of parents have a hard time distinguishing between changing moods and teen depression, according to a national poll conducted by the Mott Children’s Hospital. A good place to start is to look for these seven behaviors. Any one of these could indicate the presence of an underlying mental health condition, which can be assessed by a mental health professional.

  1. Your teen has stopped reaching out. Parents often notice during the teen years that their child doesn’t want to spend as much time with them as they used to. This is the age when adolescents do tend to move away from parents as their primary source of connection; although it can feel like a big loss for parents, this type of differentiation is critical for adolescents to go through. However, if teens are not connecting with peers, rarely coming out of their room unless forced to and not turning to parents for support, even though they seem to be struggling, these are warning signs. We are all isolating to some degree right now, but if a teen is isolating from everyone, even close friends and family members, that is a cause for concern.
  2. They are abusing drugs or alcohol or engaging in risky behaviors. Curiosity about drugs and alcohol is to be expected during adolescence, and even mild experimentation with substances can still fall within the range of normal teenage behavior (although it is not ideal). However, when teens are drinking or using substances to the point where their behavior and decisions are being negatively impacted, that can be a sign that intervention is needed. Drug paraphernalia in their room, binge drinking, lying about the amount of substance use, significant changes in appearance, or hanging out with a new friend group may all be indicators that a teen is self-medicating with substances. A family history of substance use is also a significant risk factor. Similarly, although it is typical for teens to experiment with their boundaries around sexuality and new interests, if parents notice that teens are engaging in dangerous sexual activities, this would be cause for concern.
  3. Childhood trauma is resurfacing. Our brains are wired to be hypervigilant for signs of distress or trauma, particularly for those who have a preexisting history of traumatic experiences. Throughout the pandemic, we have been experiencing a collective trauma of sorts, which has led to uncomfortable triggers for individuals who have experienced trauma in the past. Parents of teens who have survived abuse or other traumatic events should listen to their teen when they express concerns over nightmares, flashbacks and dissociative symptoms. It’s also important to remember that your teen’s past trauma may be related to family dynamics in some way. If they aren’t comfortable talking to you, offer them resources where they can feel safe speaking openly.
  4. They are self-harming and/or talking about suicide. Curiosity about suicide in the abstract is normal for teens, and parents do not need to shy away from those conversations. However, if teens start to talk about making a suicide attempt themselves, or use language like “No one would miss me,” “I’m a burden” or “The world is better off without me,” parents should take action immediately. While self-harm is not necessarily a suicidal behavior, it does also indicate an urgent need for assessment and possible support from a mental health professional. You can find mental health professional resources here.
  5. Their academic performance has drastically declined. Throughout the pandemic, we have seen that teens who used to enjoy school and excel academically may be less motivated and not as engaged in remote or hybrid schooling. But a steep decline in grades or a complete loss of interest in school is worth further investigation.
  6. There is a family history of trauma or other mental health conditions. There is a genetic component to many mental health conditions, and the ramifications of significant trauma can be transmitted over generations, so adolescents with this history are particularly vulnerable. Parents with this family history may need additional support as well, so they can create a stable foundation from which to support their teen. And as stated above, it’s always important to provide resources to your teen, should they not feel comfortable discussing trauma, particularly family-related trauma, with you.
  7. Your teen’s personality has changed significantly. Moodiness, grumpiness and a tendency to challenge authority can be expected during adolescence. Teens are balancing complex hormonal shifts and an increasing need for independence — not to mention a global pandemic and a heightened political climate. However, if your teen, who has recently been outgoing and communicative, becomes sullen and withdrawn, that can be cause for concern. Even for teens who tend to challenge authority, if parents notice a rise in violent or aggressive behavior, it would be helpful to seek assessment or treatment. If parents notice feelings of worthlessness, intense sadness or irritability that last more than two weeks, I would recommend reaching out for support from a professional.

Finally, just because many teens are going through similar emotions and adjustments doesn’t mean it’s okay to dismiss troubling behaviors. Depression shows up in different ways for different people. If parents recognize potential warning signs of depression in a teenager, the best course of action is to access professional help and make sure your teen has a comprehensive mental health assessment. I will always err on the side of advising a parent or caregiver to have their child screened; early diagnosis and treatment of depression, as well as any co-occurring disorders, dramatically improves treatment outcomes. The sooner parents learn how to distinguish if their teen is living with depression and take the appropriate action, the sooner that child — and the whole family — can be on a path toward healing.